Adult-onset temporal lobe epilepsy suspicious for autoimmune pathogenesis: Autoantibody prevalence and clinical correlates

PLoS One. 2020 Oct 29;15(10):e0241289. doi: 10.1371/journal.pone.0241289. eCollection 2020.

Abstract

Temporal lobe adult-onset seizures (TAOS) related to autoimmunity represent an increasingly recognized disease syndrome within the spectrum of epilepsies. In this context, certain autoantibodies (autoABs) were often associated with limbic encephalitis (LE). Here, we aimed to gain insights into (a) the distribution of 'neurological' autoABs (neuroABs, defined as autoABs targeting neuronal surface structures or 'onconeuronal' ABs or anti-glutamate acid decarboxylase 65 (GAD65) autoABs) in a large consecutive TAOS patient cohort, to characterize (b) clinical profiles of seropositive versus seronegative individuals and to find (c) potential evidence for other autoABs. Blood sera/cerebrospinal fluid (CSF) of TAOS patients (n = 800) and healthy donors (n = 27) were analyzed for neuroABs and screened for other autoABs by indirect immunofluorescence on hippocampal/cerebellar sections and immunoblots of whole brain and synaptosome lysates. Serological results were correlated with clinico-neuropsychological features. 13% of TAOS patients (n = 105) were neuroAB+, with anti-GAD65 and anti-N-methyl-D-aspartate receptors (NMDAR) as most frequent autoABs in this group. In our screening tests 25% of neuroAB- patients (n = 199) were positive (screening+), whereas all control samples were negative (n = 27). Intriguingly, key clinico-neuropsychological characteristics including magnetic resonance imaging (MRI) findings, epileptiform electroencephalographic (EEG) activity, and inflammatory cellular infiltrates in CSF were shared to a greater extent by neuroAB+ with neuroAB-/screening+ patients than with neuroAB-/screening- patients. Serological testing in a large consecutive TAOS patient series revealed seropositivity for anti-GAD65 autoABs as the most frequent neuroAB. Intriguingly, neuroAB+ individuals were virtually indistinguishable from neuroAB-/screening+ patients in several major clinical features. In contrast, neuroAB-/screening- TAOS patients differed in many parameters. These data support the potential presence of so far unrecognized autoABs in patients with TAOS.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antibody Specificity*
  • Autoantibodies* / blood
  • Autoantibodies* / cerebrospinal fluid
  • Autoantibodies* / immunology
  • Autoimmune Diseases* / blood
  • Autoimmune Diseases* / cerebrospinal fluid
  • Autoimmune Diseases* / immunology
  • Epilepsy, Temporal Lobe* / blood
  • Epilepsy, Temporal Lobe* / cerebrospinal fluid
  • Epilepsy, Temporal Lobe* / immunology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prevalence

Substances

  • Autoantibodies

Grants and funding

This work was supported by Else Kröner-Fresenius-Stiftung (2016_A05 to JP, MD-stipend EKFS-Promotionskolleg ‘NeuroImmunology’ to JCK, AJB), the Deutsche Forschungsgemeinschaft (SFB 1089 to AJB, SS; FOR 2715 to AJB, SPP 1757 to SS) & the BONFOR program (AJB, SS, JP) and a Junior Researcher Group (JP) of the University of Bonn Medical Faculty.